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Comparing the cost-per-QALYs gained and cost-per-DALYs averted literatures
Peter J Neumann1, Jordan E Anderson1, Ari D Panzer1
1Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
Gates Open Research
|September 25, 2019
Summary
Cost-effectiveness analyses (CEAs) using cost per quality-adjusted life year (QALY) and cost per disability-adjusted life year (DALY) have grown significantly. Research focus varies by region and disease burden, indicating potential funding gaps for understudied conditions.
Area of Science:
- Health Economics
- Comparative Effectiveness Research
- Global Health
Background:
- Cost-effectiveness analyses (CEAs) are crucial for healthcare decision-making.
- Two prominent metrics, cost per quality-adjusted life year (QALY) gained and cost per disability-adjusted life year (DALY) averted, are commonly used.
- Understanding the similarities and differences in studies utilizing these metrics is essential.
Purpose of the Study:
- To compare and contrast studies employing cost per QALY gained versus cost per DALY averted metrics.
- To analyze trends in CEA research based on intervention type, funding, geography, and disease.
- To assess the alignment between disease burden and research attention in the CEA literature.
Main Methods:
- Utilized the Tufts Medical Center CEA Registry (cost-per-QALY studies) and the Global Cost-Effectiveness Analysis (GHCEA) Registry (cost-per-DALY studies).
- Examined study characteristics: intervention type, sponsor, country, and primary disease.
- Compared publication numbers to disease burden across geographic regions.
Main Results:
- Identified 6,438 cost-per-QALY and 543 cost-per-DALY studies published through 2016, showing rapid growth.
- Cost-per-QALY studies predominantly focused on pharmaceuticals and interventions in high-income countries.
- Cost-per-DALY studies concentrated on infectious diseases and interventions in low/lower-middle-income countries.
- While disease burden generally correlates with study attention, some conditions (e.g., neonatal disorders) appear under-studied, while others (e.g., HIV, TB) seem over-studied.
Conclusions:
- The CEA literature has expanded substantially, covering diverse interventions and diseases.
- Discrepancies between disease burden and publication frequency highlight potential funding opportunities for under-researched conditions.
- Future research should consider addressing these identified gaps in cost-effectiveness analysis.
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